tbuckley/cabot-search huggingface dataset:
Abstract P371: Estimating Cost-Effectiveness of Exercise Based Cardiac Rehabilitation for Older Patients With Atrial Fibrillation
Authors: Romil Parikh, Viraj Shah, Prachi Patel, Ashwin Pillai, Rajeev Salunke, Nishka Shetty, Radhika Parikh, Tapan Mehta
Journal: Circulation (2023)

Introduction: Observational evidence from real world data suggests that providing cardiac rehabilitation (CR) to older patients with incident atrial fibrillation (AF) is associated with lower risk of all-cause mortality and re-hospitalization. We leveraged these data to estimate cost-effectiveness of extending Medicare coverage for exercise based CR to older AF patients. Hypotheses: Exercise based CR for older patients with incident AF is cost-effective at a conventional willingness to pay threshold of $50,000 per quality adjusted life year (QALY). Methods: A cost-utility analysis was conducted using a decision tree to compare initiation of exercise-based CR with standard care versus standard care alone for older patients with incident AF. Outcomes considered were re-hospitalization and all-cause mortality. A systematic review was conducted to obtain inputs for model parameters. Paucity of research did not allow meta-analyses. Estimated risks &amp; related uncertainty intervals for re-hospitalization and death were obtained from a published propensity score matched analysis of electronic health records data pooled from 41 health care organizations in the United States of America and the United Kingdom. In this study, CR + standard care versus standard care alone was associated with lower odds of all-cause mortality (odds ratio, 0.32, 95% uncertainty interval 0.29, 0.35) and re-hospitalization (odds ratio, 0.56, 95% uncertainty interval, 0.53, 0.59) over 18 months of follow-up. Estimations for costs and QALY were obtained from USA based, peer-reviewed, published studies. Probabilistic sensitivity analysis was conducted to account for uncertainty in estimates. Data analysis was performed from healthcare perspective using Microsoft Excel software. Results: In a hypothetical cohort of 10,000 older patients with incident AF (mean age, 68 years, 71% male, 84% White), estimated costs per QALY gained for CR + standard care was about $2659 and standard care alone was about $2455. Providing CR was associated with an estimated incremental cost of $10,374 per incremental QALY gained. Probabilistic sensitivity analysis showed that CR had a &gt;75% chance of being cost-effective at a willingness to pay threshold of $50,000 per QALY. Conclusions: Findings from our simulation study based on real world evidence suggest that extending Medicare coverage for exercise based CR to older patients with incident AF may be potentially cost-effective. Implementing such a policy change requires evidence from a large randomized controlled trial that overcomes design-related limitations identified in previous observational and small, randomized interventional research studies.
Abstract P423: Adding Salt to Foods is Associated With the Risk of Incident Chronic Kidney Diseases
Authors: Rui Tang, Minghao Kou, Xuan Wang, Hao Ma, Xiang Li, Yoriko Heianza, Lu Qi
Journal: Circulation (2023)

Introduction: We recently found the frequency of adding salt to foods could reflect a person’s long-term salt taste preference and intake and was related to the risk of cardiovascular diseases. Whether adding salt to foods is related to chronic kidney disease (CKD) remains unknown. Hypothesis: We assessed the hypothesis that the frequency of adding salt to foods was associated with incident CKD risk in a general population of adults. Methods: A total of 465,288 participants initially free of CKD at baseline from the UK Biobank cohort with completed information on adding salt were analyzed in this study. Incident CKD cases were identified by ICD-10 codes and OPCS-4 codes. Cox proportional hazard models were used to estimate the association between the frequency of adding salt to foods and incident CKD. Results: During a median follow-up of 11.8 years, we documented 22,031 incident events of CKD. A higher frequency of adding salt to foods was significantly related to a higher CKD risk after adjustment for sex, age, race, body mass index (BMI), Townsend deprivation index, smoking, drinking, regular physical activity, high cholesterol, cardiovascular diseases (CVD), diabetes at baseline. Compared with the “never/rarely” group, the adjusted HRs (95% CI) of “sometimes”, “usually”, and “always” groups were 1.03 (0.99, 1.07), 1.07 (1.02, 1.11), 1.12 (1.06, 1.19), respectively ( P -trend&lt;0.001). In addition, we found that estimated glomerular filtration rate (eGFR), BMI and physical activity significantly modified the associations, which were more pronounced in participants with higher level of eGFR, and lower level of BMI or physical activity (P-interaction=0.003, 0.004 and 0.02, respectively). Conclusion: Our findings for the first time indicate that a higher frequency of adding salt to foods is associated with a higher CKD risk in the general population.
Abstract P543: Longitudinal Change in Perceived Loneliness Among Older Adults During the COVID-19 Pandemic: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Anna Kucharska-Newton, Joe Coresh, Melissa Minotti, Kimberly Ring, Lynne Wagenknecht, Timothy M Hughes, Silvia Koton, Asma Sharaf, Thomas Mosley, Priya Palta, Elizabeth Oelsner
Journal: Circulation (2023)

Introduction: We and others observed that social distancing enforced early in the COVID-19 pandemic led to an increase in loneliness, a social condition associated with adverse mental and physical health outcomes. Here, we examine longitudinal changes in perceived loneliness over the first two years of the COVD-19 pandemic among older adults participating in the Atherosclerosis Risk in Communities (ARIC) Study. Hypothesis: Perceived loneliness decreased over the course of the pandemic. Methods: The UCLA 3-item Loneliness questionnaire, which assesses lack of companionship, feeling left out, and feeling isolated, to classify level of perceived loneliness, was administered to ARIC participants in March-October 2020 and again in August 2020-March 2022 as part of the Colllaborative Cohort of Cohorts for COVID-19 Research (C4R). Prepandemic measures (Jan-March 2020) were available in a subset. For each item, response categories “hardly ever”, “some of the time” and “often” were scored from 1 to 3, respectively, and added to create a final score ranging from 3 to 9 (higher scores indicating greater loneliness). T-tests were used to compare mean loneliness score values between the measurement periods. Mixed effects linear regression models were fit to examine predictors of change in the loneliness score. Results: Among 2,335 ARIC cohort participants with repeat assessments of loneliness during the COVID-19 pandemic (mean age 82.4 (SD 4.4) years, 64.8% female, 18.5% Black), mean perceived loneliness score decreased from 4.40 (SD 1.51) to 3.78 (SD 1.25) (p-value &lt;0.01) over median follow-up of 10.7 (SD 3.8) months. In 516 participants with pre-pandemic measures, the mean perceived loneliness score was 3.63 (SD 1.13). In analyses adjusted for age, the decrease in the loneliness score during the pandemic was greater by 0.65 (95% CI: 0.46, 0.84) units among Black, as compared to White participants. Male sex was likewise associated with a 0.89 (95% CI: 0.77, 1.02) unit decrease in the loneliness score. No differences were observed by educational attainment, age, or levels of the Area Deprivation Index. Conclusion: Despite reporting greater loneliness during the first six months of the COVID-19 pandemic compared to the time prior to the pandemic, older adults reported similar levels of perceived loneliness in the second year of the pandemic compared to pre-pandemic levels. In particular, Black race and and male sex were associated with greater reductions in loneliness over the pandemic period. These results suggest that older adults were psychologically resilient with respect to the extreme social changes associated with the COVID-19 pandemic.
Abstract P609: Polyphenol Metabolite Production Displays Individual Variability and Associations With Usual Diet: A Dietary Challenge Study
Authors: Jessica Sprinkles, Anju Lulla, Jonathan Shea, Beth MacIntosh, Martin Kohlmeier, Katie A Meyer
Journal: Circulation (2023)

Background: Fruits and vegetables, rich in polyphenolic compounds, contribute to cardiovascular disease (CVD) prevention. Polyphenolic metabolism is complex and relies on the gut microbiota, which in turn is shaped by usual diet. Individual variability in metabolite production has implications for precision nutrition approaches to CVD prevention. Methods: Forty healthy adults were recruited from the Kannapolis, NC, area for a 3-day dietary challenge study [2019; ages: mean (SD)=39.1 (12.3); sex (n=23 female, 17 male); race/ethnicity (n=28 non-Hispanic White, 1 Hispanic White, 5 Black, 4 Asian, 2 mixed race); BMI: mean (SD)=25.4 (3.1)]. On Day 1, participants were provided 2 days of meals, designed to be low in precursors of target metabolites and prepared in a metabolic kitchen; completed the Diet History Questionnaire II (DHQ-II); and had clinical measures taken by trained clinic staff. On Day 2, participants received a combination dietary challenge, including cocoa capsules (750 mg cocoa flavanols) and pomegranate juice (500 mL). Participants collected their urine (not pooled) for 24 hours, from challenge to the morning of Day 3. Targeted LC-MS analysis was conducted on samples within the collection period. Multivariable-adjusted linear regression was used to test associations between urine metabolite concentration and past-year consumption of foods, with multiple comparisons adjusted by the false discovery rate. Results (Table): Valerolactones displayed large variability in post-challenge production. Metabolite production was significantly associated with usual intake of several food groups. Conclusion: Our findings document appreciable variability in the production of valerolactones, after ingesting constant amounts of precursor-containing products, potentially contributing to differential dietary effects on CVD. Metabolite production was significantly associated with usual intake of several major food groups.
Abstract P412: The Effect of Targeted Therapeutic Management in ST-Elevation Myocardial Infarction Cardiac Arrest
Authors: Ibrahim Ahmed, Mohamed Ahmed
Journal: Circulation (2023)

Introduction: ST-elevation myocardial infarction (STEMI) is a known cause of cardiac arrest (CA). Little is known about the impact of targeted therapeutic management in CA patients with STEMI (SCA). Our aim was to investigate the effect of TTM on SCA. Methods: This was a retrospective cohort study using the 2019 Nationwide Inpatient Sample database to identify admissions in adults with diagnoses of CA and STEMI. Regression models were adjusted for demographic variables. Primary outcome was mortality, and secondary outcomes were length of stay (LOS) and total charge in USD. Results: Out of 13895 admissions with SCA, 440 underwent TTM. Compared to Non-TTM-SCA cohort, TTM-SCA cohort had fewer females (18.18% vs 31.03,p&lt;0.05), more males (81.82% vs 68.97,p&lt;0.05), lower mean age (62.17 vs 64.57,p&lt;0.05), more Native American (2.27% vs 0.63%,p&lt;0.05), less South region hospitals (25.00% vs 39.95%,p&lt;0.05), less acute respiratory failure with hypercapnia (0.47% vs 8.53%,p&lt;0.05), acute respiratory failure with hypoxia (1.94% vs 38.90%,p&lt;0.001), history of cardiac arrest (0.11% vs 0.61%,p&lt;0.01), ventricular fibrillation (2.27% vs 50.59%,p&lt;0.001), cerebral infarction (0.29% vs 4.28%,p&lt;0.05), more alcohol abuse (12.50% vs 4.72%,p&lt;0.001), and more persistent vegetative state (1.14% vs 0.15%,p&lt;0.05). Compared to Non-TTM-SCA, TTM-SCA group had similar mortality rates (38.64% vs 42.96%,p=0.3940), mortality OR 1.04 (95%CI 0.66-1.62,p=0.869), higher mean LOS 10.69 vs 6.25 days (95%CI 2.39-6.17,p&lt;0.001), and higher mean total hospitalization charge $238960.90 vs $179880.10 (95%CI 18772.87-98404.78,p&lt;0.01). Conclusion: In SCA patients, TTM presence had no difference in mortality rate, odds of mortality, but had higher mean LOS and total hospitalization charge. TTM was associated with fewer females, more males, lower mean age, more Native Americans, less acute respiratory failure, history of cardiac arrest, ventricular fibrillation, cerebral infarction, and more alcohol abuse and persistent vegetative state.
Abstract P546: Depressive Symptoms and Perceived Stress Are Associated With Post-Acute Sequelae of Sars-CoV-2 Infection
Authors: Oluwabunmi V Ogungbe, Nwakaego Nmezi, Sarah Slone, Khadijat Adeleye, Ruth-Alma Turkson-Ocran, Patricia Davidson, Yvonne Commodore-Mensah
Journal: Circulation (2023)

Introduction: Post-acute sequelae of SARS-CoV-2 infection (PASC), a constellation of disabling symptoms, persisting after COVID-19, is an emerging health issue affecting substantial number of persons globally and in the US. Cardiac PASC refers to the wide range of cardiovascular-specific PASC symptoms. The psychological impact of PASC, cardiac PASC is poorly characterized. Objective: To examine whether PASC and cardiac PASC symptoms are associated with depressive symptoms and high levels of perceived stress. Methods: We conducted cross-sectional analyses among persons with history of COVID-19. Exposures were self-reported PASC and cardiac PASC symptoms. Outcomes were depressive symptoms and perceived stress measured using Patient Health Questionnaire (PHQ8) and Perceived Stress Scale (PSS4), respectively. Scores on PHQ8 ranged from 0-24, and clinical cutoff for depressive symptoms was ≥10. Scores on PHQ8 were dichotomized as minimal-mild (&lt;10) and moderate-severe (≥10). Scores on PSS4 ranged from 0 to 16 with higher scores suggesting greater perceived stress. PSS4 scores were dichotomized as low/moderate (&lt;6) and high (≥6) stress. We performed logistic regression analyses, adjusting for age, sex, race and comorbidities. Results: Of 197 participants, mean age was 47.3 (±15.9) years, 74% were female, 77% were White. About 48% (95/197) reported PASC, 46% (90/197 participants) reported cardiac PASC. The odds for moderate-severe depressive symptoms (adjusted Odds Ratio [aOR]: 5.03, 95%CI: 2.43-10.41, Table ) and high perceived stress (aOR: 4.19, 95%CI: 2.17-9.08) were higher compared to those who did not report PASC. Similarly, the odds for moderate-severe depression (aOR: 2.42, 95%CI: 1.25-4.70) and high perceived stress (aOR: 2.68, 95%CI: 1.43-5.02) was higher compared to those who did not report cardiac PASC. Conclusion: PASC and cardiac PASC are associated with clinical depressive symptoms and high perceived stress. Psychological and mental health interventions should be integrated into PASC care models.
Abstract P598: Highly Purified Eicosapentaenoic Acid Use Can Reduce Neurological Severity at the Onset of Ischemic Stroke in Patients With Hyperlipidemia
Authors: Takahisa Mori, Kazuhiro Yoshioka, Yuichi Miyazaki
Journal: Circulation (2023)

Introduction: Functional outcomes after acute ischemic stroke (AIS) are related to initial neurological severity (NS). Therefore, neuroprotective drugs against ischemic injury are promising. Not only statins but also eicosapentaenoic acid (EPA) have neuroprotective effects. Hypothesis: Highly purified EPA (hp-EPA) pre-stroke may reduce NS at the onset of AIS. Methods: We retrospectively included patients with AIS and hyperlipidemia admitted to our institution between July 2012 and March 2019 from the prospectively and consecutively enrolled institutional stroke registry database. Hyperlipidemia was defined as serum values of low-density lipoprotein cholesterol (LDL-C) at arrival ≥140 mg/dl or triglycerides ≥150 mg/dl. We excluded patients: (1) admitted to our institution 24 h after AIS onset, (2) who did not stay in the hospital, and (3) in whom dyslipidemia drugs pre-stroke except the hp-EPA were administered. We collected data on age; sex; pre-stroke statin use, antiplatelets, anticoagulants, antihypertensives, and antidiabetic drugs; serum albumin, glucose, glycated hemoglobin (HbA1c), cholesterol, triglycerides, and c-reactive protein levels; pre-stroke modified Rankin scale and the National Institutes of Health Stroke Scale (NIHSS) scores; stroke subtypes at admission; hospitalizations; and home discharge. We performed a multivariable linear regression analysis to identify significant variables of NIHSS scores at arrival. Results: Of the 2,199 patients with AIS and hyperlipidemia during the study period, 691 met our inclusion and exclusion criteria, their median age was 75 years, and 18 (2.6%) received pre-stroke hp-EPA. In patients with and without pre-stroke EPA use, the median NIHSS scores were one and three, respectively. Multivariable regression analysis showed that the glucose, mRS, age, LDL-C, and anticoagulants increased the NIHSS score, albumin, HbA1c, high-density lipoprotein cholesterol, antihypertensives, antidiabetic drugs, and hp-EPA use decreased the NIHSS score. Conclusion Pre-stroke hp-EPA use reduced NS at the AIS onset in patients with hyperlipidemia and without other dyslipidemia drugs.
Abstract P651: Assessing the Pathway Between Health Care Utilization and Hypertensive Outcomes Among Young Adult African American Medicaid Beneficiaries in Delaware
Authors: Asli McCullers
Journal: Circulation (2023)

Introduction: African Americans have been studied to underutilize medical care in comparison to other groups due to a variety of factors, including lack of access and medical mistrust, both attributable long-standing systemic oppression. Thus, African Americans bare a disproportionate burden of chronic conditions, including hypertension, which is more than two times more prevalent among African Americans in comparison to other groups. To date, the health care utilization behaviors of African American young adults, ages 18-30, are understudied. Addressing this relationship in a young sample may be informative in fostering long-term improvement of health outcomes for African Americans. Question: Among African Americans aged 18-30. is there an association between hypertension diagnosis and recent receipt of a general adult medical exam? Methods: We conducted a cross-sectional case control study using data from a sample of African American Medicaid recipients living in Delaware, aged 18-30. Following an assessment of demographic characteristics, we performed logistic regression adjusted for gender and zip code to investigate the association between hypertension diagnosis and receipt of a general adult medical exam within the study period. Results: Among patients aged 18-30, those with hypertension (n=2,506) had 1.4 times the odds of reporting to have received a general adult medical exam during the study period when compared to those without hypertension (n=24526; p&lt;.0001). The difference between the mean number of visits between strata (.379 vs. .302) is statistically significant (p&lt;.0001). Conclusion: Our findings suggest that young adult African American patients living with hypertension are more likely to have a general adult medical exam during the study period than clients of the same age group without hypertension. We believe this may implicate that those with poorer health tend to seek care more often, though further research is needed to better understand motivations for seeking care. Improved understanding of the pathway between health care utilization and hypertension through a younger lens will be critical in targeting self-advocacy programs that address aversion to care-seeking behaviors for generations to come.
Abstract P227: Paradoxical Associations of Occupational and Non-Occupational Sedentary Behavior With Cardiovascular Risk Factors in Desk Workers
Authors: Abdullah Alansare, Joshua Paley, Tyler Quinn, Bethany Barone Gibbs
Journal: Circulation (2023)

Introduction: Sedentary behavior (SB) has emerged as a cardiovascular disease (CVD) risk factor, independent of physical inactivity. Yet, preliminary research suggests that these relationships may differ if SB is accumulated during occupational or non-occupational time. Thus, we examined associations of SB with CVD risk factors, by domain, in desk workers. Hypothesis: We hypothesized that non-occupational SB would have more unfavorable associations with CVD risk factors compared to occupational SB. Methods: This cross-sectional, secondary analysis of baseline data from the RESET BP clinical trial included 269 desk workers (age=45.2±11.6 years; 83.5% white; 59.3% female). Total SB was measured by activPAL3 and was partitioned into occupational and non-occupational domains. CVD risk factors included resting and nocturnal systolic/diastolic blood pressure (SBP/DBP) and heart rate (HR), resting carotid-femoral (cf) and carotid-radial (cr) pulse wave velocity (PWV), and heart rate variability (HRV) [i.e., natural log transformed standard deviation of R-R intervals (lnSDNN), root mean square of successive differences (lnRMSSD), and high frequency (lnHF)]. Adjusted linear regression estimated associations of SB with CVD risk factors. A Wald test compared the beta-coefficients associating occupational vs. non-occupation SB with these CVD risk factors. Results: Participants spent 69%, 77%, and 64% of their time in total, occupational, and non-occupational SB, respectively. Agnostic of the domains, a 1-hour increase in total SB was only associated with higher cfPWV (0.18 m/s; p&lt;0.05). A 1-hour increase in occupational SB was associated with lower (favorable) resting DBP and nocturnal SBP and DBP (-1.02, -1.52, and -1.12 mmHg, respectively; p&lt;0.05). Paradoxically, a 1-hour increase in non-occupational SB was associated with higher (unfavorable) resting DBP (1.04 mmHg), HR (1.07 beat/minute), cfPWV (0.23 m/s), nocturnal SBP (1.41 mmHg), and lower resting lnSDNN (-0.07), lnRMSSD (-0.10), and lnHF (-0.18). Wald tests revealed significant differences in beta coefficients (p&lt;0.05 for all) for all these outcomes where occupational SB was favorably associated with these CVD risk factors while non-occupational SB was unfavorably associated with these CVD risk factors. Conclusions: While desk workers accumulate high amounts of occupational and non-occupational SB, paradoxical associations with CVD risk were observed with non-occupational SB being unfavorable and occupational SB being favorable for CVD risk factors. Confirmation is needed in longitudinal and experimental studies.